Delayed onset panuveitis following intravitreal aflibercept injection

Area of Science:

• Ophthalmology
• Retinal Diseases
• Pharmacology

Background:

• Aflibercept is approved for neovascular age-related macular degeneration (nAMD) and is listed on the Australian Pharmaceutical Benefit Scheme.
• Intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents are standard treatments for nAMD.
• Delayed-onset panuveitis following intravitreal aflibercept has not been previously reported.

Observation:

• Two patients developed anterior and posterior uveitis 4 or more weeks after their initial intravitreal aflibercept injection.
• Both patients had a history of receiving other anti-VEGF inhibitors without prior inflammatory events.
• Both cases presented with sterile endophthalmitis.

Findings:

• Intravitreal aflibercept can be associated with delayed-onset sterile endophthalmitis and uveitis.
• Previous tolerance to other anti-VEGF agents does not preclude the development of uveitis with aflibercept.
• Ranibizumab treatment was reinstituted successfully after inflammation resolved.

Implications:

• Clinicians should be vigilant for delayed-onset uveitis following aflibercept treatment, even in patients with a history of tolerating other anti-VEGF agents.
• Sterile endophthalmitis is a potential complication of intravitreal aflibercept.
• Alternative anti-VEGF agents like ranibizumab may be safely used after aflibercept-induced uveitis resolves.